The Role of Primary Care Pharmacists in the Detection of Atrial Fibrillation

Atrial fibrillation (AF) affects up to 10% of ≥ 65-year-olds and contributes to one in four ischaemic strokes, costing the UK economy > £1 billion each year. Clinical pharmacists' (CPs) integration into general practitioner (GP) surgeries and care homes offers an opportunity to facilitate AF screening. This thesis aimed to explore the role of primary care CPs in AF screening excluding the community pharmacy environment. The 'Pharmacists Detecting Atrial Fibrillation' (PDAF) study recruited 604 participants aged ≥ 65 years in GP surgeries over two influenza vaccination seasons. CP-led AF screening, using pulse palpation and single-lead electrocardiogram (SLECG) devices, identified 'new' AF in 1.3% of individuals who qualified for oral anticoagulant (OAC) therapy. This intervention had a 72% probability of being cost-effective, particularly with SLECG devices rather than pulse palpation which produced 5.2% more false positive AF diagnoses. Patients, CPs and practice staff praised the convenience of screening and emphasised the role of CPs in reassuring patients. Their vision of AF screening involved a personalised cardiovascular disease (CVD) service targeting at-risk groups. The PDAF study therefore extended into care homes. A further 53 participants were recruited, and 9.6% were found to have undiagnosed AF qualifying for OAC therapy. Screening using SLECG devices in this setting was 89% cost-effective but suffered from under-recruitment, low follow-up rates and poor diagnostic accuracy. Another initiative used SLECG devices to deliver AF screening within a South Asian community setting. Pharmacy undergraduates of matching heritage screened 572 participants over nine days under CP supervision. Out of ≥ 65s, 1.5% had a newly detected AF and could be considered for OAC therapy. The intervention had a 95% probability of being cost-effective and was viewed as a valuable cause for local community, although its future implementation could be compromised by ineffective ref